1What Is the C236 OHIP Code?
C236 refers to a repeat consultation conducted by an ophthalmologist in a non-emergency hospital in-patient setting. This code applies when the same consultant reassesses a patient regarding the same ophthalmic issue previously identified, after another physician has provided interim care. The repeat consultation must be prompted by a new written referral from a referring medical professional. These consultations are crucial for following up on complex cases like retinal diseases or post-infective reassessment, ensuring continuity and quality in patient care.
Clinicians often miss this billing opportunity by failing to document the new written referral or misunderstanding the requirements distinguishing repeat consultations from regular follow-ups. Moreover, the nuances in the required documentation can lead to misbilling and reduced fees.
2Related Codes
| Code | Name | Frequency | Description |
|---|---|---|---|
| A935 | Special surgical consultation | As needed | $194.65 fee for intricate surgical consultations requiring specialized expertise in ophthalmology. |
| C935 | Special surgical consultation | As needed | A variant of A935 applicable for specific ophthalmological settings. |
| A231 | Neuro-ophthalmology consultation | As needed | $155.45 fee for consultations involving neuro-ophthalmologic issues. |
| A235 | Consultation | Once per patient consultation | $86.25 fee for standard ophthalmological consultations. |
3Eligibility Requirements
To bill C236 for a repeat consultation, ensure that the service is provided in a non-emergency hospital in-patient setting. Each C236 service must include a new written request from a referring physician, nurse practitioner, or dental surgeon, kept on file in the consulting physician’s medical record. Exceptions to this document retention exist in settings like hospitals where common records are maintained. If these requirements are not met, the billed amount will default to a lower assessment fee. Note that this service can also be provided virtually via video call only, billed as C236A.
4What Your Clinical Note Must Show
Each repeat consultation billed under C236 must include specific documentation:
- A new written consultation request signed by the referring physician, nurse practitioner, or dental surgeon.
- Ensure the referral request is filed correctly in the consulting physician’s records, unless shared records are used.
- Detailed notes on the examined issue, reflecting continuity from the patient’s previous consultations and treatments.
5Weak vs. Strong Note Examples
The strong note succeeds by clearly documenting the referrer’s details, specific clinical findings, and linking the assessment to an explicit referral, providing a comprehensive overview required for proper billing. The weak note fails due to its lack of specificity and absence of essential documentation confirmations.
Consulted on patient with retinal issue. Follow-up after treatment by ward team. Plan set.
Repeat consultation on patient John Doe for reassessment of retinal detachment diagnosed earlier during admission. Previous treatment initiated by Dr. Smith (referrer) on 10/01/2023. Written referral filed. Exam finds mild improvement; recommendations for continued therapy as documented.
- Referring physician's details
- Consultation date and clinical details tied to the specific referral
- Clinical observations and advice informed by the current assessment
